Chaplaincy as ‘Tragic Improv’
An Interview with Erica Rose Long
Rev. Erica Rose Long, MDiv ’16 (left) and Sarah Byrne-Martelli, MDiv ’02. Courtesy photo
On May 2, 2020, Harvard Divinity School published a Q&A with two chaplains who serve at Massachusetts General Hospital in Boston. Titled “A Joyful Sorrow,” the article was wildly popular, so we decided that Bulletin readers would appreciate follow-up interviews with these illustrious HDS alumnae. In late August, editor-in-chief Wendy McDowell had separate Zoom conversations with Erica Rose Long, MDiv ’16, and Sarah Byrne-Martelli, MDiv ’02, to find out more about the role of a hospital chaplain, how they are coping personally with the stresses of a pandemic, and in what ways their faith traditions inform the work they do each day.
Have you been able to reflect on the spring COVID surge? What has been occupying your thoughts, and your time, over the summer?
It feels so long ago, even though it was just a few months ago. But I also feel like I haven’t actually had as much time to reflect on it, or maybe I haven’t been as eager to reflect back on the surge, because the intensity has just changed. It hasn’t gone away.
A big thing for me in my work has been helping staff after the murders of George Floyd and Breonna Taylor. I’ve been doing a lot of work with staff around racial justice and white supremacy culture in medicine. I’m a part of a couple of different committees for diversity inclusion. Especially because I work in psychiatry and mental health, that’s been a huge emphasis. And to be honest, it’s not separate from the experience of COVID-19 because, for so many of us, we saw the health discrepancies firsthand. I know, for me, logging on each day and seeing that so many of the patients in the ICU who were COVID-positive were Spanish-speaking from Chelsea, I felt the impact of that.
Many of the nurses and the staff were already aware of these inequities, but it was just so much more pronounced and so much more urgent. People are really dying in all these different ways, from police violence, from COVID-19, and we’ve had to look at it all in a new, more focused way. That’s been a lot of the intensity of my work. And then there is also the intensity of constant changes happening. It feels like every week we’re reevaluating what our best practices are now, and what our schedule is going to be, and what do we do if the second wave comes.
I had a vacation for a little while, but I didn’t have much time to process what we went through. We did have some psychologists who met with us to debrief as a team, in the spiritual care department, about what our experience was during COVID. A lot of that was processing how COVID impacted us as a team, how we had to rely on each other in different ways, how some of us took on different responsibilities, and working through some of those interpersonal, interprofessional challenges. So we had some time to do that.
Can you say a little more about how you are going about tackling issues of racial injustice, and how this relates to health-care inequities, in your specific context?
Within the Department of Psychiatry, I’m a member of the Department for Psychiatry Center for Diversity and Inclusion. I’ve been a part of that center for over a year now, and I’m also a member of an interdisciplinary group for diversity, equity and inclusion on the inpatient psychiatric unit. We’re still defining our mission, but a lot of our work is to offer education about diversity and inclusion, to have a place to practice talking honestly about issues of race, and to talk about the experiences of all of our patients. We’ve heard from medical students and residents who are people of color who come through the inpatient psychiatric unit and experience racism there.
As an interdisciplinary team, we are trying to face that head on and to work together to change that as much as we can. That committee has also been together for about a year, but it has changed since the death of George Floyd. I worked with a social worker to facilitate a conversation with the staff reflecting on everything that was happening in our country about a week after George Floyd’s murder. It was really powerful to hear people from all different generations and different backgrounds who work on the inpatient psych unit talking about where they were in this moment, and what their hopes were for themselves and for the country.
From that discussion, we’ve had more people join the committee, and we now have weekly meetings. It’s a balancing act, though, trying to work within the hospital structure to have these conversations, which is pretty different from working in a congregation or working at HDS. We’re figuring out how to have these really vulnerable conversations about race and racial difference and racism and white supremacy culture, and what it looks like to do this in the hospital.
I’m really grateful for my colleagues. We’re all navigating this together. I had another meeting yesterday with the team and we continue to have regular discussions. It’s something we’re actively working on.
The hospital, as a whole, has a ten-point strategic plan for what it is trying to do to dismantle racism and white supremacy in our work at MGH. But it also has to happen individually, because every floor is its own culture, every department is its own culture.
This is something I’ve taken on because of my own passions and interests. I gained a lot of experience at Harvard Divinity School leading conversations like this with other students, and so I feel like I can bring some of those skills to the psych unit.
You’re right, this is a specific—and important—skill, and it’s great you have been able to develop it. Do you find you get better at it as you go?
I don’t know if I have, but I have done this work in a few different contexts now. Between some of the experiences I had working with other students to lead conversations about race at HDS, and then also as a Unitarian Universalist minister, I’d already been having these conversations in my congregation and with my colleagues. And I’ve done other trainings. It’s a really big part of my faith as a Unitarian Universalist and my call to ministry. So while it’s been very challenging, it’s also exciting to be able to bring that work to the hospital.
To not feel like it’s off limits or not important . . .
Yes. I feel like, before George Floyd, we were doing that work, but often we were talking about implicit bias. We were not sharing specific case examples of when racism came into play in the care of a patient. And now, we can have much more explicit conversations. At least, that’s what it feels like to me.
Do you feel like it’s gotten real?
Yeah, it’s gotten real! Another thing I helped with was to do the tech for a service we did after the death of George Floyd—I did not lead the service but offered help. It was a Zoom service, which is a new kind of technology we’re doing. We used to do services in the chapel, and now all of our services are over Zoom.
It was a short service. I think we called it “service for healing and renewal.” But the point was acknowledging especially what a lot of our clinicians who are people of color were feeling at that time. The request for the service came from a nursing leader who is a person of color. We had over 300 people attend, which is more than we’ve ever had at any service that I know of.
So there have been moments like that where there’s obviously a deep spiritual need to have these conversations and to do this work.
That’s something unique that chaplains can bring: to address this in a more ritualized space or in a way that includes people’s spiritual selves. Do you think different kinds of healing can take place in different settings and different spaces?
Yes, and we were very intentional about the service. Even though I was doing the technology, all the people who spoke were black leaders, African American leaders, from the hospital, and the music was by black and African American artists. We put the focus there because that’s what the need was.
I’ve learned a lot from these two moments—going through COVID and everything I had to learn about how to work from home, how to use technology I’d never used before, how to support a patient and their family when I’m not physically with them. I feel like I’m having a similar experience where I’m trying to learn how best to have these conversations about race and racism at the hospital, and how to support real transformation and change, hopefully.
There is a thoughtful essay in this issue of the Bulletin that argues that lauding health care workers as “heroes” may actually serve to distance them from the wider community, and render them unable to express the full range of feelings that are natural, given what has been asked of them (exhaustion, fear, anxiety, grief, anger). Have you experienced this yourself, or seen it in other health-care workers?
I definitely have seen what the author describes. For me, it has been twofold. It’s mixed because, at the peak of the surge, being called a hero and having people send us food, having people reach out to us, meant so much. I did talk to some staff who felt mixed about it, but for a lot of folks, it was incredibly meaningful to have something warm to eat, to get love and support from the community.
At the same time, where we are now—a few months out—I think almost every department in health care is facing the economic impact of the pandemic. It’s hard to feel like a hero when we’re feeling so stressed. And when I think about the exhaustion, the distress, the anger, and the grief that clinical staffs are facing right now, the one thing that’s really going to make that change is health-care reform.
If our patients have what they need, if they have a fair chance to be cared for outside of the hospital so that it reduces them needing to come to the hospital, if we have a place that we can discharge patients so that we’re not discharging them to the street—that’s best for us, too. We don’t literally discharge anyone to the street, but we have a homelessness crisis in our country, and it may get worse with the evictions that people are facing because of what our economy is going through, and the unemployment rate—all of those things cause distress to health-care workers. So sometimes it’s hard to feel like a hero when you go to work and you’re so aware of what many patients are facing. I hear so many people say, “We just can’t do it all!” There’s only so much we can do. We really need bigger changes to happen.
Right, because though you do and will continue to do everything you can, in fact you aren’t superheroes!
It’s hard right now, to be honest. That’s another thing people need to know—the distress hasn’t completely gone away, it’s just changed. And that seems true for a lot of the different health-care providers I talk to in my work. It’s definitely better than during the surge, when there was an overwhelming feeling of the death that we were seeing and the uncertainty of how long it was going to go on, and the general fear and stress that all of us were experiencing at that time—it’s not quite at that level. But there is still a lot of distress.
I think about what people went through in New York City and what people are going through in other parts of the world. What we went through here in Boston wasn’t like what some people went through elsewhere.
Still, even seeing just what I saw here in Boston, I really don’t want us to have to go through that again. It was so awful. And if there’s anything we can do to prevent that, I think it’s worth it. Because we can’t get those people back. We can’t get that time back.
What was that time like for you, personally? In the psychiatric unit, were you working from home the entire time, or did you go back in person?
I was actually one of the few people who worked on site, because with my health and my demographics, I’m someone who could go on site relatively safely. So I do work on the inpatient psychiatric unit, but I also work in the neuro ICU, which became a COVID ICU. And I work in the respiratory acute care unit, so I’ve been working with patients after they’re well enough to get out of the ICU, but they’re still on a ventilator. And I have a general medicine unit that was the first floor to receive COVID and COVID-risk patients last winter, and they continue to be a floor where patients are ruled out for COVID.
So I work from home two days a week, but I’ve been going on site two to three days a week the whole time. I don’t see COVID patients in person. I talk to them on the phone, usually, and I talk to their families on the phone. But I still do a lot to get them supplies that they need. If they need sacramental care, if they’re Roman Catholic, then I help them to get that.
How does that happen? You must have relationships with other religious leaders?
Yes, we have a priest in our department who visits patients. He’s been cleared to visit patients who are COVID-positive. So he has all the training to do that, and he’s willing to, thankfully.
How big is your team? I don’t know what you consider your “team,” but for a big hospital like MGH, there must be several chaplains.
Within the spiritual care department, we have seven full-time staff chaplains, and I’m one of them. We have a CPE supervisor, the director of our department, an office administrator, Sarah—who’s adjacent to our department—and, right now, we have five residents. And then we also have the priest who comes in to help us. So in total, it’s close to 15 of us, though we have varying responsibilities and hours.
How often do the residents change? Yearly, or is it more or less often?
It’s a year-long residency at MGH. The group we have right now is graduating next Friday. Then we have a month without any residents. And we have four residents starting in October.
You mentioned talking to patients and families by phone. I’m curious about how your practices have changed during this time, and perhaps have continued to evolve.
Well, now we know how to use all the communications technology and tools. We’re not using them as much now because, to be honest, there are very few COVID patients that are inpatient who have been admitted to MGH at this particular time. I got an email this morning that has statistics of what our numbers are. I think there’s only one COVID-positive patient in an ICU right now. There are other patients who are being ruled out, but I can go in to most rooms now, so a lot of that work is back to the status quo.
However, we did learn a lot. All the nurses now know how to use iPads and to call up Zoom. One thing that still cracks me up is that I have a social worker I work with who’s been at home, she hasn’t been able to come back, and we have an iPad that we put on an IV pole. And we just kind of roll her around with us when we’re rounding. So that’s a particular kind of innovation, to have a colleague who’s a video call on an IV pole coming around with us.
I think the other place where we have learned new technology is with the services. Doing services on Zoom is very different, and there are challenges, like being worried about Zoom bombing. There’s a lot to learn about how to manage the service, how to have music work, how to have the speakers know when they’re coming in, how to mute people who call in and aren’t muted.
So we’ve had to learn all of that stuff, and I have been doing the technology for all of our services, maybe because I’m a millennial.
Always give the technology tasks to a millennial, right?
Right, but it’s also that I am eager to help. It’s something I know I can do. So I’ve been helping with the technology for all of the services we’ve been doing during this time. And services are something we’re continuing to do on Zoom, we haven’t brought those back in person yet.
Where do you get support? What has helped you cope, either from your tradition or self-care practices?
One thing that’s been interesting for me to reflect on is what has been harder for me and what is normal. I think some of the things that people expect to be hard for me were things that were already a part of my daily work before this. I’ve been offering end-of-life support to people for five years. I’m practiced at this.
That part is still sad, and it’s still hard. But what’s been most difficult for me is working from home and being away from my colleagues, and not being able to be with my psychiatric patients in person, when I know how much more effective I am when I’m physically with them. I think the constant change is hard for me, too. And there are people in my life that I can’t see because I need to protect their health. I am still going into the hospital, so I’m a risk to some of my loved ones, and that’s hard.
What’s been helping me is that I do have a great roommate, Natalie Malter, and we try to get out into nature when we can. She is also a Unitarian Universalist minister and an HDS grad, and she’s currently a PhD student at Harvard. She and I went on vacation together to the Northeast Kingdom in Vermont in August. Only 136 people live in the town where we were staying, so you can go on a walk and have your mask with you, only putting it on if you see someone. That was a nice change of pace from wearing a mask for 10 hours a day, which is what I do when I’m at work.
I also have a really supportive partner who’s in my life, and he’s been great. Just going on walks has been helpful to me. I feel like I am so attuned to all the changes in the flowers in my neighborhood, because I have been looking at them every day.
And the support of my colleagues and my friends has been crucial. When I go to work at the hospital, and I get to see my coworkers—I know that a lot of people don’t have that right now. I was recently talking to my aunt and uncle who are teachers, and they’re getting ready to go back to work. I was telling them that when I can go on site and work with other people, and interact with the nurses and the doctors and the PCAs and the environmental service staff, that helps so much.
Because right now I can’t be with my family, physically. I can’t be with my church physically, and those are two big supports in my life that I can’t interact with in person. So being able to have those interactions in my little quarantine bubble at home, and at work, has been really important for me.
Is there anything you would want people to know about what the life of a hospital chaplain is like?
It’s actually pretty wild all the time. I’ve had so many moments where I’ve thought if there was a way for my job to be a television show, it would be so interesting, given what I get to witness every moment! Maybe I’m biased, because it’s my life and I think my job is infinitely interesting.
I learned really early on in this work that you can never know what an encounter is going to be. There are times when I walk into a room and I expect everyone to be crying, and they’re all laughing, and vice versa. One of my coworkers was describing it as a kind of tragic improv. People are going through these crises and tragedies, and we get called in, and it’s like: This is the scene. Go!
It can go in any direction. It can truly go in any direction. So it keeps me on my toes. I love it. I’m grateful that I get to meet so many amazing people and witness so many powerful moments.
I love that: “tragic improv.” I agree with you on the TV show—I’ve always thought there needed to be a show about hospital chaplains, or at the very least that they should be prominent characters in hospital shows. In all your spare time, maybe you can write a TV script about chaplains!
Yes, in all my spare time. It’s a great idea. Someone should work on that!
How has your health been during this time, and have you been tested?
In some ways, I’m healthier than I’ve ever been. I normally get colds all the time, and I haven’t gotten any colds since COVID, because of wearing masks and hand hygiene.
I did have to get a COVID test because I had an asymptomatic exposure to someone who tested positive outside of the hospital. Thankfully, it was a pretty great system. MGH has a hotline for staff. They got me an appointment for a test, I got my test, and I had my results within 48 hours. I was really grateful for all the support that I had from MGH.
But there’s definitely that moment of fear when you’re unsure if you have the virus or not and what that could mean. I experienced that on a very small scale, but I can only imagine what it’s like for people who have a more serious exposure.
I think my hypervigilance comes from not wanting to expose the people in my life and wanting to be able to do my work, because a big thing for me is, if I get sick, I can’t do my work. And I really want to be present with my patients right now.
I imagine that in your work on the psych ward, you’re witnessing a lot of distress right now. While your work is always important, it must feel like it’s even more important right now.
Yes, and I don’t know if I clarified this before, but we did have COVID patients on the psych unit. It was one of the only floors with mixed COVID and non-COVID, because there were patients who had acute psychiatric conditions and had COVID-19.
Also, a lot of my work now involves leading patient groups. Twice a week I lead a spirituality group on the psych unit. That has been complicated during this time, trying to get all the patients to keep their masks on, explaining to them why we have to keep our masks on, and cleaning everything after group.
So COVID has been very present on the inpatient psychiatric unit. There’s not a place in the hospital that hasn’t been impacted by it. It’s different because our patients usually aren’t as critically ill with the virus. Most are often asymptomatic or they have mild symptoms, but it’s still disruptive and requires so much vigilance.
It’s obvious that you love your job, and you find moments of joy in it. Is that something you’d also like people to know about chaplaincy?
Yes, absolutely. For instance, I led a spirituality group yesterday, and I left the group feeling so happy and energized. We were talking about forgiveness, which is a hard, tough thing to talk about, especially for a lot of people on the unit who’ve experienced trauma, and who may have other factors in their lives contributing to their illnesses. But seeing patients care for each other, engaging them and helping them to see themselves as wise, and working with people to think about how they want to live their life—that brings me joy.
I think a lot of people may have a stereotype that hospital chaplains are there to help people think about how they want to die. But a lot of it is: How do you want to live? How do you live a life that’s aligned with your values? And how do you live a life that’s aligned with your spirituality? What do you want your life to look like? That’s a lot more of what I do.
Erica Rose Long, MDiv ’16, is a Unitarian Universalist minister and a full-time spiritual care provider (chaplain) at Massachusetts General Hospital. She is an affiliate minister at Arlington Street Church in Boston.